Provider Demographics
NPI:1427345115
Name:JONES, KATHLEEN DIANE (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:DIANE
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 9673
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61612-9673
Mailing Address - Country:US
Mailing Address - Phone:309-339-9211
Mailing Address - Fax:309-691-2530
Practice Address - Street 1:6320 N SHERIDAN RD STE B
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-3053
Practice Address - Country:US
Practice Address - Phone:309-339-9211
Practice Address - Fax:309-691-2530
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0146911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical